Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience
Abstract Background Embolic stroke of undetermined source (ESUS) encompasses diverse embologenic mechanisms, which transesophageal echocardiography (TEE) is critical to detect. Specific markers related to each embolic source in ESUS is not fully studied. We focused on D-dimer levels, and explored th...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-022-02867-z |
| _version_ | 1818064529361207296 |
|---|---|
| author | Kenichiro Hira Yuji Ueno Masao Watanabe Hideki Shimura Naohide Kurita Nobukazu Miyamoto Haruna Haginiwa Kazuo Yamashiro Nobutaka Hattori Takao Urabe |
| author_facet | Kenichiro Hira Yuji Ueno Masao Watanabe Hideki Shimura Naohide Kurita Nobukazu Miyamoto Haruna Haginiwa Kazuo Yamashiro Nobutaka Hattori Takao Urabe |
| author_sort | Kenichiro Hira |
| collection | DOAJ |
| description | Abstract Background Embolic stroke of undetermined source (ESUS) encompasses diverse embologenic mechanisms, which transesophageal echocardiography (TEE) is critical to detect. Specific markers related to each embolic source in ESUS is not fully studied. We focused on D-dimer levels, and explored the association of D-dimer with potential embolic sources (PES) identified on TEE in ESUS. Methods Consecutive patients with ESUS were included in this study. Clinical characteristics including D-dimer levels were compared between ESUS patients with and without TEE, and among none of, one, and at least two PES in ESUS patients undergoing TEE. Factors related to elevation of D-dimer were analyzed. Results A total of 211 patients (age, 69.3 ± 13.2 years; 149 males) with ESUS were enrolled. Of these, 115 received TEE, displaying significantly younger age and lower D-dimer levels than patients without TEE (P < 0.05), and 20 (17%), 61 (53%), and 34 (30%) patients were classified into none of, one, and ≥ two PES, respectively. On multiple logistic regression analysis, D-dimer levels were related to one PES (odds ratio [OR]: 9.01; 95% confidence interval [CI]: 1.00–81.51; P = 0.050) and PES ≥ two (OR: 9.76; 95% CI: 1.07–88.97; P = 0.043). Right-to-left shunt (RLS) with deep venous thrombosis (DVT)(OR: 13.94; 95% CI: 1.77–109.99; P = 0.012) and without DVT (OR: 3.90; 95% CI: 1.20–12.70; P = 0.024) were associated with elevation of D-dimer. Conclusions D-dimer levels were higher in patients with PES. Among PES, RLS, with and without DVT, were associated with increase of D-dimer in ESUS. |
| first_indexed | 2024-12-10T14:37:27Z |
| format | Article |
| id | doaj.art-e928070e58924909a284eadfa876c987 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-10T14:37:27Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-e928070e58924909a284eadfa876c9872022-12-22T01:44:47ZengBMCBMC Neurology1471-23772022-09-0122111110.1186/s12883-022-02867-zImpact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experienceKenichiro Hira0Yuji Ueno1Masao Watanabe2Hideki Shimura3Naohide Kurita4Nobukazu Miyamoto5Haruna Haginiwa6Kazuo Yamashiro7Nobutaka Hattori8Takao Urabe9Department of Neurology, Juntendo University Urayasu HospitalDepartment of Neurology, Juntendo University School of MedicineDepartment of Neurology, Juntendo University Urayasu HospitalDepartment of Neurology, Juntendo University Urayasu HospitalDepartment of Neurology, Juntendo University Urayasu HospitalDepartment of Neurology, Juntendo University School of MedicineDepartment of Neurology, Juntendo University School of MedicineDepartment of Neurology, Juntendo University Urayasu HospitalDepartment of Neurology, Juntendo University School of MedicineDepartment of Neurology, Juntendo University Urayasu HospitalAbstract Background Embolic stroke of undetermined source (ESUS) encompasses diverse embologenic mechanisms, which transesophageal echocardiography (TEE) is critical to detect. Specific markers related to each embolic source in ESUS is not fully studied. We focused on D-dimer levels, and explored the association of D-dimer with potential embolic sources (PES) identified on TEE in ESUS. Methods Consecutive patients with ESUS were included in this study. Clinical characteristics including D-dimer levels were compared between ESUS patients with and without TEE, and among none of, one, and at least two PES in ESUS patients undergoing TEE. Factors related to elevation of D-dimer were analyzed. Results A total of 211 patients (age, 69.3 ± 13.2 years; 149 males) with ESUS were enrolled. Of these, 115 received TEE, displaying significantly younger age and lower D-dimer levels than patients without TEE (P < 0.05), and 20 (17%), 61 (53%), and 34 (30%) patients were classified into none of, one, and ≥ two PES, respectively. On multiple logistic regression analysis, D-dimer levels were related to one PES (odds ratio [OR]: 9.01; 95% confidence interval [CI]: 1.00–81.51; P = 0.050) and PES ≥ two (OR: 9.76; 95% CI: 1.07–88.97; P = 0.043). Right-to-left shunt (RLS) with deep venous thrombosis (DVT)(OR: 13.94; 95% CI: 1.77–109.99; P = 0.012) and without DVT (OR: 3.90; 95% CI: 1.20–12.70; P = 0.024) were associated with elevation of D-dimer. Conclusions D-dimer levels were higher in patients with PES. Among PES, RLS, with and without DVT, were associated with increase of D-dimer in ESUS.https://doi.org/10.1186/s12883-022-02867-zEmbolic stroke of undetermined sourceTransesophageal echocardiographyPatent foramen ovaleD-dimer |
| spellingShingle | Kenichiro Hira Yuji Ueno Masao Watanabe Hideki Shimura Naohide Kurita Nobukazu Miyamoto Haruna Haginiwa Kazuo Yamashiro Nobutaka Hattori Takao Urabe Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience BMC Neurology Embolic stroke of undetermined source Transesophageal echocardiography Patent foramen ovale D-dimer |
| title | Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience |
| title_full | Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience |
| title_fullStr | Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience |
| title_full_unstemmed | Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience |
| title_short | Impact of D-dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source: a single-center experience |
| title_sort | impact of d dimer for pathologic differentiation on transesophageal echocardiography in embolic stroke of undetermined source a single center experience |
| topic | Embolic stroke of undetermined source Transesophageal echocardiography Patent foramen ovale D-dimer |
| url | https://doi.org/10.1186/s12883-022-02867-z |
| work_keys_str_mv | AT kenichirohira impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT yujiueno impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT masaowatanabe impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT hidekishimura impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT naohidekurita impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT nobukazumiyamoto impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT harunahaginiwa impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT kazuoyamashiro impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT nobutakahattori impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience AT takaourabe impactofddimerforpathologicdifferentiationontransesophagealechocardiographyinembolicstrokeofundeterminedsourceasinglecenterexperience |